Heartburn...I went down, down, down and the flames went higher...and it burns, burns, burns...the ring of fire, the ring of fire.

WOW. This one is a bitch. One of two things will happen to you:

[1] You will have heartburn early on in pregnancy and suffer like a hero throughout

[2] You'll be a smartass like me and proudly dance around like a fairy on acid as you tell the world you didn't get heartburn...then you'll get it in the last ten weeks and you'll get it OH SO BAD and won't be able to tell anyone because you've been such an ass.

So, what is heartburn and why do you get it in pregnancy? "Heartburn is a burning sensation that often extends from the bottom of your breastbone up to your lower throat. It happens when acid from your stomach is brought up into your gullet (oesophagus). The acid may flow back up (reflux) into your throat or mouth, leaving a sour and bitter taste." 

Translation: This isn't a sour and bitter taste, it's like molten lava infused with chilli.

What causes heartburn in pregnancy? "Hormonal and physical changes in your body during pregnancy can cause temporary symptoms such as heartburn and acid reflux. An increase in the hormone progesterone when you’re pregnant relaxes the smooth muscles of your womb (uterus). Experts believe this hormone also relaxes the valve that separates your gullet from your stomach. This allows gastric acids to seep back up your gullet, causing a burning sensation. Progesterone also slows down the wave-like contractions of your stomach, making your digestion sluggish. In later pregnancy, your growing baby pushes your intestines and stomach upwards. This slows digestion and forces acids up from your stomach into your gullet." 

Translation: There's a flap that stops things coming back up. Progesterone stops it closing and what goes down mixes with acid and comes back up. In later stages, the incredible baby bulge moves all of your innards up and gives this a helping a hand to burn you further.

How do you avoid heartburn? There's an endless list but here are a few:

• Avoid high fat (no cake and steak)
• Don't smoke (if you are already then you are absolutely crazy anyway - i'm not preaching, I had to give up too on positive test day...deal with it.)
• Avoid sucking lemons (more likely if you're a smoker and just read my comments above)
• Eat little and often...think tapas but with less fun foods
• Eat 3 hours before bed...which for those of you still working full-time as I am, either eat as you do your last conf call or go to bed insanely late
• Don't get drunk...the advice says don't drink at all for a stack of reasons but alcohol is a huge trigger for this so avoid at all costs. The advice also says replace drinking with exercise but that's a step too far for me and enough to make me jump off Beachy Head
• Sleep sitting up...I know...but it works. Angle your pillows so you are not totally flat and it actually does make a difference

So what can you do once you have it? Gaviscon. It's a life-saver. Buy it in liquid, sachets, tablets...whatever, but buy it in volume. You may not need it today but when you do need it, in the dead of the night, you'll need it FAST!!! If this doesn't work, go to see your GP as there are prescription versions available that are stronger and safe to use in pregnancy. If you have Gestational Diabetes, you can get sugar-free Gaviscon. Liquids are sugar-free, tablets are not. Read more here.

If you're not into your hardcore drugs and prefer to take the hippie route there are a number of natural remedies. 

Given some of the complexities of natural remedies, i'm at pains to type them here as many can induce anything from labour to cramps when used in pregnancy, but that's not to say they aren't amazing. Start here and Google would be my advice.

Perineal Massage - What IS This???

Daily perineal massage may increase the area's ability to stretch, leading to less need for an episiotomy and fewer natural tears

During our NCT antenatal class we were given loads of amazing information. As a follow-up, we received an email with a summary and a few attachments. I asked my better half to print them off so I could read them in bed but when he finished printing he said: "Honey, did you actually look at these attachments? There are some things in there that I don't recall us discussing...". He looked a little ashen so I had a quick look through the print-outs. This is the first thing I saw:

My better half and I are very close and very open with one another, but this definitely wasn't a diagram we had seen before. The information that accompanied this diagram was as follows:

"This is a great exercise to do with your partner. First of all, wash your hands and find a private place and sit or lean back in a comfortable position with your legs spread open and knees relaxed. Your partner should put a lubricant such as KY jelly, cocoa butter, olive oil, vitamin E oil or pure vegetable oil on your thumbs and around the perineum. Place your thumbs about 1 to 2 inches (three to four centimeters) inside your vagina. 

Press downward and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning, tingling or stinging sensation. With your thumbs, hold the pressure steady for about two minutes or until the area becomes a little numb and you don't feel the tingling as much. As you keep pressing with your thumbs, slowly and gently massage back and forth over the lower half of your vagina, working the lubricant into the tissues. 

Keep this up for three to four minutes. Remember to avoid the urinary opening.  As you massage, pull gently outward (and forward) on the lower part of the vagina with your thumbs hooked inside. This helps stretch the skin much in the same way that the baby’s head will stretch it during birth."

Ok...let's just hold on a second here...

1. There is absolutely no way I can manage this myself as I have enough difficulty wiping my own backside now that I am the size of an elephant
2. If my better half comes anywhere near me with an intent to "firmly keep stretching" until I feel "a slight burning", I will cut his crown jewels off and serve them up for supper.

I have asked our midwife about whether or not we really should be doing this and her view is that it won't really make much difference and if you are going to tear, you are going to tear. I think we will sit this one out and take our chances...

There are so many things that pop up during pregnancy that nobody thinks to mention to you and I understand that this is part embarrassment and part selective memory. My intention on here is to share all I hear so it doesn't come as much as a shock to you as it did to us :)

Further Information on Perineal Massage